Not so long ago, Medical billing departments and services collected nearly every dime of medical practice revenue. Other staff would have little to no involvement in collecting money from patients, with the exception of copays at check-in. Patients would be billed, usually for small balances, after EOBs were submitted by insurance companies. However, health plan terms have changed dramatically in recent years. Patient obligations for copays, coinsurance, and deductibles now make up a much larger share of practice revenue – and take a larger chunk out of the patients’ disposable income. Collecting these patient payments properly means rethinking processes and involving non-billing staff in financial conversations with patients.

The biggest change has been that most insured patients now face some sort of deductible – and 30 to 40% have high-deductible health plans (HDHPs), defined by the CDC as plans with deductibles of more than $1,200. These deductibles mean that insurance companies won’t pay a cent towards the cost of many services patients receive, until the deductible amount is paid out of pocket. On some plans, even routine office visits must be paid for by the patient, until the deductible is met. Collecting these payments after services are rendered can be very challenging, and patient balances can quickly become bad debt.

If your practice is inclined to “leave billing to the billers,” as was common in the days of fewer and smaller deductibles, consider what happens when your practice sees a patient with a significant deductible. The patient walks out the practice door without thinking about financial implications – possibly even assuming that insurance covered the cost completely. Then, the bill from your practice arrives many weeks later. The long delay between your billing team’s processing of the claim and the arrival of the EOB from the patient’s insurance, makes it quite likely that the bill will come as a surprise to the patient. Depending on the type of service and the amount of the patient’s deductible, the bill could be a big and unpleasant surprise indeed.

When your patients are surprised by unexpected bills, there’s a good chance that many of them won’t want to pay. Some will simply not have the cash on hand and be too embarrassed to admit it. Others will be convinced that their bills are wrong or that insurance will eventually pay. Even those who will ultimately agree to pay will cost your practice money if they’re confused about the bill, and will call your staff to complain or seek clarification. Some patients who maybe angry about receiving an “incorrect” bill, may leave your practice altogether; they might even share negative comments online and hurt your practice’s reputation. Your billers will respond to non-payment by sending multiple statements over several months (each at a significant cost). Sometimes, those statements will not result in any payment at all.

The bottom line is that if you wait until your superbills reach your billing department to address patients’ financial obligations, you will almost certainly will lose money you could collect with a more proactive process. At the minimum, engaging patients and educating them about their financial responsibilities can avoid “surprises” that upset patients and lead to bad debt.

To be effective, these conversations need to happen before the patient visits your practice. Schedulers and receptionists are on the front lines of educating patients about their financial obligations – that also means educating the patients about health plan terms, too. Solid training on how to help patients prepare to meet their financial obligations will make the task less stressful for your team.  Make sure your team also has access to the technology they need; tools like eligibility checking, estimation, credit-cards-on-file, and payment plans will arm your team to do a better job of managing this increasingly important responsibility.

Laurie Morgan is a partner and senior consultant for Capko & Morgan, with experience in marketing, business operations, and strategic consulting. She is also the author of the practice management book People, Technology, Profit: Practical Ideas for a Happier, Healthier Practice Business.